The Doctor's Corner: Estrogen is not to be avoided

Do you have a friend, aunt, mother, cousin, sister or spouse who is suffering from sweats, flushes, vaginal dryness, exhaustion and the mental fogginess that comes with falling hormones during menopause? Could this be you?

Even women who traverse the menopausal chasm cool as a cucumber should take note. Important new opinions of experts from all over the world should encourage many women to start estrogen therapy within 10 years of menopause or before age 60. This applies only to women who want to live longer.

Yale School of Medicine's esteemed Dr. Philip Sarrel published a pivotal work in the July 2013 issue of the American Journal of Public Health. Using government data, he reported on mortality over the 10-year span since 2002, when the media blitz from the Women's Health Initiative (WHI) occurred.

The WHI was ceremoniously terminated early in July 2002 because of adverse effects of combined synthetic estrogen and progesterone. The latter, called progestogen, was the component associated with breast cancer, heart attacks and strokes.

Sarrel did a brilliant thing. As a physician scientist having researched estrogen for half a century, he suspected that "estrogen avoidance," precipitated by misunderstanding the conflated data, would lead to mortality. (It is estimated that only one third of women who are candidates for estrogen therapy are currently using it.)

To simplify his calculations, Sarrel looked only at women who had undergone a hysterectomy and were thus without a uterus. These women generally have no indication of the need for progesterone. Therefore, he could estimate the effect of estrogen alone. By the way, estrogen is the component of hormone therapy that alleviates many of the unpleasant menopausal symptoms and provides the principal long-term benefits.

His results are stunning and startling. He calculated that in the past decade in the U.S., as many as 91,500 women who had had hysterectomies died prematurely because of estrogen avoidance.

Furthermore, a consensus statement by menopause experts from all over the world, published in the April 2013 issue of Climacteric, concludes that estrogen therapy may lessen coronary artery disease and all-cause mortality when started within 10 years of menopause or before the age of 60.

Additionally, these experts opine that any link between breast cancer and the use of hormone therapy principally stems from the progestogen component, which can be avoided. The dreaded weight gain that befalls most women as life moves on has actually been shown to be less in women who take hormones.

We all know that bad news travels fast and good news can languish, in this case in professional medical journals. Understanding the shift in expert opinion, based on medical research, toward use of estrogen therapy within 10 years of menopause or before age 60 is a critical public health issue, since 10 million American women make this transition annually.

There is a strong rationale for delivery of estrogen across the skin, rather than in pill form. Therapy needs to be individualized. Custom-compounded bioidentical hormones are not recommended by the experts.

In the spirit of full disclosure, I am a medical speaker for pharmaceutical companies making bioidentical estrogen. This article is for general information only and is not a substitute for individual consultation with one's healthcare provider.

DR. JANE K. BENING is a board certified gynecologist who has lived in Laguna Beach and has had a private gynecology practice in Newport Beach for 22 years. She can be reached at ask@drjanebening.com or at her office (949) 720-0206.